Croaker's dilemma--should prison physicians serve prisons or prisoners?

PRISON PHYSICIANS may be asked to evaluate inmates' physical ability to withstand corporal punishment and, periodically, to determine whether punishment can be continued.' The participation of physicians in punishment and execution of prisoners is an extreme example of a dilemma facing all physicians employed by authoritarian and punitive systems to which their patients are committed. A prison physician's practice requires actions that are in the interests of either the prison or the prisoners, but sometimes unfavorable to the other. In fact, the dilemma of whose interest physicians are serving permeates nearly every aspect of prison medical practice. When physicians' actions cannot be in the interests of both, whom shall they serve: the prison or the prisoner? Medical ethics dictate that patients are physicians' foremost responsibility, so it would seem that there is no dilemma. Yet it may be inherently impossible for prison physicians to meet their responsibility to patients when the institution seeks complete authority over their patients' lives.2 Inmates often charge collusion between physicians and prison officials, and even the term croaker, which many inmates call doctors, implies disdain for their physicians' position. Leo L. Stanley was known as San Quentin's Chief Croaker for about 40 years. His career began there in 1913. After 27 years in the institution he wrote his story in Men at Their Worst and revealed not only a progressive attitude to-